Denials Specialist

Octave Bioscience

About the Company

Octave Bioscience is at the forefront of precision care, delivering data-driven insights for neurodegenerative diseases, starting with multiple sclerosis (MS). We’re on a mission to transform clinical decision-making through predictive analytics and biomarker intelligence.

Summary:

Under general supervision of the Denial and Appeal Manager, the Denials Specialist serves as the primary point of contact for the frontline identification, categorization, and resolution of denied claims. This position involves reviewing denied claims, identifying reasons for the continued or new denials, and determining the appropriate steps needed to secure payment.

Critical to this position is the profound ability to effectively appeal denied technical and clinical claims, and file payer reconsiderations. Also critical to this position is the ability to effectively identify the core denial and write appeal letters specific to each denial as well as providing timely and effective follow-up.

Responsibilities:

• Review payer remittance advice (EOB/ERA) on unpaid claims to identify claim denials and categorize by denial reason codes
• Investigate root causes of denials (coding errors, eligibility, authorization, documentation gaps, etc.) and determine most effective process to overturn the core denial reason(s)
• Compile all necessary information and documentation, including medical records, to support efforts to overturn denials
• Perform timely resubmission of corrected claims for rejected claims
• Track rejection and denial trends and provide feedback/reports to management for process improvement
• Research state and health plan specific rules and regulations on the process of overturning denials and submitting appeals
• Maintain current and in-depth knowledge of government and third-party payer billing regulations and guidelines
• Assist in audit preparation and ensures compliance with regulations (HIPAA, CMS, state-specific)

Reports to: Denials & Appeals Manager

Location: Remote

Schedule: This remote position will follow a Monday–Friday schedule in alignment with our core team operations.

Salary Range

$65K - $75K + Bonus + Equity + Benefits. The successful candidate's starting base salary will be determined based on experience, qualifications and market conditions.